Healthcare Provider Details

I. General information

NPI: 1073236881
Provider Name (Legal Business Name): EHAB SAMAAN DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N LAKEWOOD BLVD
LONG BEACH CA
90808-1558
US

IV. Provider business mailing address

4200 N LAKEWOOD BLVD
LONG BEACH CA
90808-1558
US

V. Phone/Fax

Practice location:
  • Phone: 562-420-1701
  • Fax: 562-421-8447
Mailing address:
  • Phone: 562-420-1701
  • Fax: 562-421-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MR. EHAB SEDKY SAMAAN
Title or Position: DDS
Credential:
Phone: 562-420-1701